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Nurs 3100 Exam 3 Midterm Assessment Questions with Correct Detailed Answers.

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When performing an abdominal examination on a client, which assessment technique should the nurse perform first? - auscultation - palpation - percussion - inspection - Answer inspection A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates the correct way to assess the client for ascites? -auscultate for bowel sounds in all 4 quadrants -palpate the abdomen lightly for areas of tenderness -inspect the abdominal skin for vascularity -percuss the flanks from the bed upward toward the umbilicus - Answer percuss the flanks from the bed upward toward the umbilicus Which action by the nurse will facilitate relaxation of the abdominal muscles during examination of the abdomen? -raise the client's arms or fold them behind the head -avoid the use of a pillow behind the head during examination -provide privacy to the client and instruct them to relax -flex the client's legs by placing a pillow under the knees - Answer flex the client's legs by placing a pillow under the knees A nurse cares for a client with a distended abdomen due to peritonitis. Which parameter should the nurse measure to assess improvement? - auscultate for bowel sounds - palpate the abdomen - measure abdominal girth

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Subido en
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Nurs 3100 Exam 3 Midterm Assessment
Questions with Correct Detailed
Answers.
When performing an abdominal examination on a client, which assessment technique should
the nurse perform first?



- auscultation

- palpation

- percussion

- inspection - Answer inspection



A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates
the correct way to assess the client for ascites?



-auscultate for bowel sounds in all 4 quadrants

-palpate the abdomen lightly for areas of tenderness

-inspect the abdominal skin for vascularity

-percuss the flanks from the bed upward toward the umbilicus - Answer percuss the flanks
from the bed upward toward the umbilicus



Which action by the nurse will facilitate relaxation of the abdominal muscles during examination
of the abdomen?



-raise the client's arms or fold them behind the head

-avoid the use of a pillow behind the head during examination

-provide privacy to the client and instruct them to relax

-flex the client's legs by placing a pillow under the knees - Answer flex the client's legs by
placing a pillow under the knees



A nurse cares for a client with a distended abdomen due to peritonitis. Which parameter should
the nurse measure to assess improvement?

, - perform percussion for tympany - Answer measure abdominal girth



A nurse observes tenderness over the costovertebral angle on the right side. The nurse
recognizes this as an abnormal finding for which organ?



- gallbladder

- liver

- spleen

- kidney - Answer kidney



Which change in auscultation of bowel sounds should the nurse recognize as diagnostic of an
intestinal obstruction?



- an increase in the pitch

- no sound heard in 1 minute

- increase in the frequency of the gurgles

- a soft click every 5-15 seconds - Answer an increase in the pitch



During the abdominal exam, the nurse supports the client's right knee and ankle, flexing the
client's hip and rotating the leg internally and externally. At this point, the client reports pain in
the RLQ. This test is positive for which sign?



- Rovsing's

- Obturator

- Psoas

- Murphy's - Answer Obturator



A nurse inspects a client's abdomen and notices a large bulge is present in the RLQ. How should
the nurse further assess this finding using inspection?



- palpate to measure the diameter of the mass

- percuss to determine if the mass is fluid filled


- have the client cough forcefully a few times
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